This document provides an overview of diabetes mellitus (DM), including the three main types (Type 1, Type 2, and gestational diabetes), signs and symptoms, complications, pathophysiology, oral manifestations, dental management considerations, emergency management, diagnosis, and treatment. DM is caused by either the pancreas not producing enough insulin or cells not responding properly to insulin, resulting in high blood sugar levels. The document compares and contrasts the characteristics of Type 1 and Type 2 DM.
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
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Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
A comprehensive presentation on Diabetes Mellitus for undergraduate students from medical /dental/biotechnology /pharmacology education.It describes causes, classification, symptoms ,diagnostic biochemical tests,biochemical changes in metabolism,Management, drugs used for DM .Google images relevant to text are presentation.
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
A comprehensive presentation on Diabetes Mellitus for undergraduate students from medical /dental/biotechnology /pharmacology education.It describes causes, classification, symptoms ,diagnostic biochemical tests,biochemical changes in metabolism,Management, drugs used for DM .Google images relevant to text are presentation.
These slides content the explanation of what happen in Diabetes Melitus exactly. By learn how it could happen, may it be beneficial and help people in preventing the disease.
All what you have to know about Diabetes MellitusYapa
All what you have to know about Diabetes Mellitus is here.Introduction of Diabetes,Regulation of blood glucose,Predisposing factors of DM,Clinical presentation,DM and pregnancy ,Diabetes ketoacidosis ,Complications of DM ,Diagnosis ,Dietary management of DM & Prevention of DM.
Student seminar on Diabetes Mellitus presented by 2007/2008 Batch students of Faculty of Medicine,University of Peradeniya,Sri Lanka.
This presentation was delivered by 3rd year MBBS students of Frontier Medical College during 4th Clinico-Pharmacological Conference held in the Pharmacology Dept of College. The Presentation aims at providing key features in detail about diabetes and its Pharmacological treatment. The Presentation was well applauded by the Faculty and students of Medical College. (Abbottabad, Pakistan).
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel. The main cause of diabetes varies by type.
L-PRF for increasing the width of keratinized mucosa around implants: A split...MD Abdul Haleem
Journal Club Presentation: L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.
Interproximal tunneling with a customized connective tissue graft a microsurg...MD Abdul Haleem
Journal Club Presentation - Interproximal Tunneling with a Customized Connective Tissue Graft A Microsurgical Technique for Interdental Papilla Reconstruction.
Releasing Incisions Using Upward-Motion Scissors Technique for Flap Mobilizat...MD Abdul Haleem
Journal Club Presentation - Releasing Incisions Using Upward-Motion Scissors Technique for Flap Mobilization for Guided Bone Regeneration or Periodontal Surgery: Technical Introduction and a Case Report.
Analysis of buccolingual dimensional changes of the extraction socket using t...MD Abdul Haleem
Journal Club Presentation - Analysis of buccolingual dimensional changes of the extraction socket using the "ice cream cone" flapless grafting technique
Entire papilla preservation technique in the regenerative treatment of deep i...MD Abdul Haleem
Journal Club Presentation - Department of Periodontology and oral implantology - Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-Year results
Coronal advanced flap in combination with a connective tissue graft. Is the t...MD Abdul Haleem
Coronal advanced flap in combination with a connective tissue graft. Is the thickness of the flap a predictor for root coverage? - A prospective clinical study.
Department of Periodontology and Oral Implantology.
"A Journal Club Presentation"
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
5. INTRODUCTION
Diabetes mellitus (DM), is a group of metabolic
diseases in which there are high blood sugar levels over
a prolonged period.
Symptoms of high blood sugar include frequent urination,
increased thirst, and increased hunger.
6. If left untreated, diabetes can cause many complications.
Acute complications can include diabetic
ketoacidosis, nonketotic hyperosmolar coma, or death.
Serious long-term complications include heart
disease, stroke, chronic kidney failure, foot ulcers,
and damage to the eyes.
7. Diabetes is due to either the pancreas not producing
enough insulin or the cells of the body not responding
properly to the insulin produced.
There are three main types of diabetes mellitus:
Type 1 DM
Type 2 DM
Gestational Diabetes
8. Type 1 DM
Results from the pancreas's failure to produce enough
insulin.
This form was previously referred to as "insulin-
dependent diabetes mellitus" (IDDM) or "juvenile
diabetes".
The cause is unknown.
9. Type 2 DM
Begins with insulin resistance, a condition in which
cells fail to respond to insulin properly.
This form was previously referred to as "non insulin-
dependent diabetes mellitus" (NIDDM) or "adult-onset
diabetes".
The primary cause is excessive body weight and not
enough exercise.
10. Is the third main form
and occurs in
pregnant women
without a previous
history of diabetes
Gestational Diabetes
11. COMPARISON OF TYPE 1 AND 2 DIABETES
Feature Type 1 diabetes Type 2 diabetes
Onset Sudden Gradual
Age at onset Mostly in children Mostly in adults
Body size Thin or normal Often obese
Ketoacidosis Common Rare
Autoantibodies Usually present Absent
Endogenous
insulin
Low or absent
Normal,
decreased
or increased
Concordance
in identical twins
50% 90%
Prevalence ~10% ~90%
13. SIGNS AND SYMPTOMS
The classic symptoms of untreated diabetes are
weight loss
polyuria (increased urination)
polydipsia (increased thirst) and
polyphagia (increased hunger).
Symptoms may develop rapidly (weeks or months) in
type 1 DM, while they usually develop much more slowly
and may be subtle or absent in type 2 DM.
14. In addition they also include:
Blurry vision
Headache
Fatigue
Slow healing of cuts and
Itchy skin.
Prolonged high blood glucose can cause glucose
absorption in the lens of the eye, which leads to changes
in its shape, resulting in vision changes.
A number of skin rashes that can occur in diabetes are
collectively known as diabetic dermadromes
SIGNS AND SYMPTOMS
15. COMPLICATIONS
All forms of diabetes increase the risk
of long-term complications. These
typically develop after many years
(10–20)
The major long-term complications
relate to damage to blood vessels.
Diabetes doubles the risk
of cardiovascular disease
About 75% of deaths in diabetics are
due to coronary artery disease.
Other "macrovascular"
diseases (stroke)
peripheral vascular disease.
16. COMPLICATIONS
The primary complications of diabetes due to damage in
small blood vessels include damage to the eyes, kidneys,
and nerves.
Damage to the eyes, known as diabetic retinopathy, is
caused by damage to the blood vessels in the retina of
the eye, and can result in gradual vision loss
and blindness.
Damage to the kidneys, known as diabetic nephropathy,
can lead to tissue scarring, urine protein loss, and
eventually chronic kidney disease, sometimes
requiring dialysis or kidney transplant.
Damage to the nerves of the body, known as diabetic
neuropathy, is the most common complication of diabetes.
17. COMPLICATIONS
The symptoms can include
numbness, tingling, pain, and altered
pain sensation, which can lead to
damage to the skin.
Diabetes-related foot
problems (such as diabetic foot
ulcers) may occur, and can be
difficult to treat, occasionally
requiring amputation.
Additionally, proximal diabetic
neuropathy causes painful muscle
wasting and weakness – Diabetic
Amyotrophy.
18. PATHOPHYSIOLOGY - GENERAL
Insulin is the principal hormone that regulates the uptake
of glucose from the blood into cells of the body, especially
liver, adipose tissue and muscle, except smooth muscle, in
which insulin acts via the IGF-1 (Insulin-like growth factor -
1).
Therefore, deficiency of insulin or the insensitivity of
its receptors plays a central role in all forms of diabetes
mellitus.
19. PATHOPHYSIOLOGY
The body obtains glucose from
three main places:
The intestinal absorption of food
The breakdown of glycogen, the
storage form of glucose found in the
liver
Gluconeogenesis, the generation of
glucose from non-carbohydrate
substrates in the body.
20. PATHOPHYSIOLOGY
Insulin plays a critical role in balancing glucose
levels in the body:
It can inhibit the breakdown of glycogen or the
process of gluconeogenesis.
It can stimulate the transport of glucose into
fat and muscle cells.
It can stimulate the storage of glucose in the
form of glycogen.
21. PATHOPHYSIOLOGY
Insulin is released into the
blood by beta cells (β-cells),
found in the islets of
Langerhans in the pancreas, in
response to rising levels of
blood glucose, typically after
eating.
Lower glucose levels result in decreased insulin release
from the beta cells and results in the breakdown of
glycogen to glucose.
This process is mainly controlled by the
hormone glucagon, which acts in the opposite manner to
insulin.
22. PATHOPHYSIOLOGY
If the amount of insulin available is insufficient
If cells respond poorly to the effects of insulin
If the insulin itself is defective
Then glucose will not be absorbed properly by the body
cells
The net effect is persistently high levels of blood glucose,
poor protein synthesis, and break down of fat storage
Acidosis.
23. PATHOPHYSIOLOGY
When the glucose concentration in the blood remains
high over time, the kidneys will reach a threshold
of reabsorption Glycosuria.
This increases the osmotic pressure of the urine
polyuria increased fluid loss
Lost blood volume will be replaced osmotically from
water held in body cells and other body compartments
dehydration polydipsia
24. PATHOPHYSIOLOGY - TYPE 1
Type 1 diabetes mellitus is characterized by loss of the
insulin-producing beta cells of the islets of Langerhans in
the pancreas, leading to insulin deficiency.
This type can be further classified as immune-mediated
or idiopathic.
The majority of type 1 diabetes is of the immune-
mediated nature, in which a T-cell-
mediated autoimmune attack leads to the loss of beta
cells and thus insulin.
25. PATHOPHYSIOLOGY - TYPE 1
Most affected people are otherwise healthy and of a
healthy weight when onset occurs.
Sensitivity and responsiveness to insulin are usually
normal, especially in the early stages.
oType 1 diabetes can
affect children or adults,
but was traditionally
termed "juvenile
diabetes" because a
majority of these
diabetes cases were in
children.
26. PATHOPHYSIOLOGY - TYPE 1
Type 1 diabetes is partly inherited, with multiple genes,
including certain HLA genotypes, known to influence the
risk of diabetes.
In genetically susceptible people, the onset of diabetes
can be triggered by one or more environmental factors,
such as a viral infection or diet.
Among dietary factors, gluten may lead to type 1
diabetes, but the mechanism is not fully understood
27. PATHOPHYSIOLOGY - TYPE 2
Type 2 DM is characterized by insulin resistance.
The defective responsiveness of body tissues to
insulin is believed to involve the insulin receptor.
In the early stage of type 2, the predominant
abnormality is reduced insulin sensitivity.
Type 2 DM is due primarily to lifestyle factors and
genetics.
28. PATHOPHYSIOLOGY - TYPE 2
A number of lifestyle factors are known to be important to
the development of type 2 DM, including
Obesity
lack of physical activity
poor diet
Stress
Dietary factors also influence the risk of developing type 2
DM such as
sugar-sweetened drinks
Type of fats in diet
saturated fats and trans fatty acids increasing the risk
polyunsaturated and monounsaturated fat decreasing the risk
Eating lots of white rice also may increase the risk of diabetes.
A lack of exercise is believed to cause 7% of cases
29. PATHOPHYSIOLOGY - GESTATIONAL DIABETES
Gestational diabetes mellitus (GDM) resembles type 2 DM
in several aspects.
Involves a combination of relatively inadequate insulin
secretion and responsiveness.
It occurs in about 2–10% of all pregnancies and may
improve or disappear after delivery.
30. PATHOPHYSIOLOGY - GESTATIONAL DIABETES
However, after pregnancy approximately 5–10% of
women with gestational diabetes are found to have
diabetes mellitus, most commonly type 2.
Gestational diabetes is fully treatable, but requires
careful medical supervision throughout the
pregnancy.
Management may include dietary changes, blood
glucose monitoring, and in some cases, insulin may
be required.
31. PATHOPHYSIOLOGY - GESTATIONAL DIABETES
Risks to the baby include:
Macrosomia (high birth
weight)
Congenital Heart Defects
Central Nervous
System Abnormalities
Skeletal
Muscle Malformations.
oThough it may be transient, untreated
gestational diabetes can damage the health of
the fetus or mother.
32. PATHOPHYSIOLOGY - GESTATIONAL DIABETES
A high blood bilirubin level may
result from red blood cell
destruction.
Increased levels of insulin in a
fetus's blood may inhibit
fetal surfactant production and
cause respiratory distress
syndrome.
33. PATHOPHYSIOLOGY - GESTATIONAL DIABETES
In severe cases, perinatal death
may occur, most commonly as a
result of poor placental perfusion
due to vascular impairment.
Labor induction may be indicated with decreased placental
function.
A Caesarean section may be
performed if there is marked fetal
distress or an increased risk of
injury associated with macrosomia,
such as shoulder dystocia.
34. ORAL MANIFESTATIONS AND
COMPLICATIONS
No specific oral lesions associated with diabetes. However,
there are a number of problems by presence of hyperglycemia.
Periodontal disease:
Microangiopathy alters antigenic challenge.
Altered cell-mediated immune response and impaired
of neutrophil chemotaxis.
Increased Ca+ and glucose lead to plaque formation.
Increased collagen breakdown.
36. ORAL MANIFESTATIONS AND
COMPLICATIONS
Salivary glands
Xerostomia is common, but reason is unclear.
Tenderness, pain and burning sensation of tongue.
May cause secondary enlargement of parotid glands with sialosis.
Dental caries
Increase caries prevalence in adult with diabetes. (xerostomia,
increase saliva glucose)
Hyperglycemia state shows a positive association with dental
caries.
38. Increased risk of infection
Reasons unknown, but macrophage metabolism
altered with inhibition of phagocytosis.
Peripheral neuropathy and poor peripheral circulation
Immunological deficiency
High sugar medium
Decrease production of Antibodies
Candidal infection are more common and adding
effects with xerostomia
ORAL MANIFESTATIONS AND
COMPLICATIONS
39. Delayed healing of wounds
Due to microangiopathy and ultilisation of protein for
energy, may retard the repair of tissues.
Increase prevalence of dry socket.
Miscellaneous conditions
Pulpitis : degeneration of vascular.
Neuropathies : may affect cranial nerves. (facial)
Drug side-effects : lichenoid reaction may be associated
with sulphonylureas (chlopropamide)
Ulcers
ORAL MANIFESTATIONS AND
COMPLICATIONS
40. DENTAL MANAGEMENT
CONSIDERATIONS
To minimize the risk of an intraoperative emergency,
clinicians need to consider some issues before initiating
dental treatment.
Medical history:
• Glucose levels
• Frequency of hypoglycemic episodes
• Medication, dosage and times.
• Consultation
41. DENTAL MANAGEMENT
CONSIDERATIONS
Scheduling of visits
• Morning appointment
• Do not coincide with peak activity.
Diet
• Ensure that the patient has eaten normally and taken
medications as usual.
Blood glucose monitoring
• Measured before beginning. (<70 mg/dL)
Prophylactic antibiotics
• Established infection
• Pre-operation contamination wound
• Major surgery
42. DENTAL MANAGEMENT
CONSIDERATIONS
During treatment
• The most complication of DM occur is hypoglycemia episode.
• Hyperglycemia
After treatment
• Infection control
• Dietary intake
• Medications : salicylates increase insulin secretion and
sensitivity avoid aspirin.
43. EMERGENCY MANAGEMENT
Hypoglycemia
Initial signs : mood changes, decreased spontaneity,
hunger and weakness.
Followed by sweating, incoherence, tachycardia.
Results in unconsciousness, hypotension,
hypothermia, seizures, coma, even death.
44. EMERGENCY MANAGEMENT
15 grams of fast-acting oral carbohydrate.
Measured blood sugar.
Loss of consciousness: 25-30ml 50% dextrose solution iv.
over 3 min period.
Glucagon 1mg.
45. EMERGENCY MANAGEMENT
Severe hyperglycemia
A prolonged onset
Ketoacidosis may develop with nausea, vomiting,
abdominal pain and acetone odor.
Difficult to different hypoglycemia or
hyperglycemia.
46.
47. EMERGENCY MANAGEMENT
Hyperglycemia needs medical intervention and
insulin administration.
While emergency, give glucose first !
Small amount is unlikely to cause significant
harm.
48. DIAGNOSIS
Can be diagnosed by demonstrating any one of the
following:
Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)
Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) two hours
after a 75 g oral glucose load as in a glucose tolerance
test.
Symptoms of high blood sugar and casual plasma
glucose ≥ 11.1 mmol/l (200 mg/dl)
Glycated hemoglobin (HbA1C) ≥ 48 mmol/mol
(≥ 6.5 DCCT %)
49. DIAGNOSIS
Oral Glucose Tolerance Test (OGTT)
Measures the body's ability to metobolise
glucose
Most commonly done to check for gestational
diabetes.
The patient is asked to take a glucose drink
and their blood glucose level is measured
before and at intervals after the sugary drink is
taken.
For the standard glucose tolerance test, we
should drink 75 grams or 100 grams.
50.
51. OGTT RESULT’S :
People without diabetes
Fasting value (before test): under 6 mmol/L
At 2 hours: under 7.8 mmol/L
People with impaired glucose tolerance (IGT)
Fasting value (before test): 6.0 to 7.0 mmol/L
At 2 hours: 7.9 to 11.0 mmol/L
Diabetic levels
Fasting value (before test): over 7.0 mmol/L
At 2 hours: over 11.0 mmol/L
52. WHO DIABETES DIAGNOSTIC CRITERIA
Condition
2 Hour
Glucose
Fasting
Glucose
HbA1c
Unit
mmol/l
(mg/dl)
mmol/l
(mg/dl)
mmol/m
ol
DCCT %
Normal <7.8 (<140) <6.1 (<110) <42 <6.0
Diabetes
mellitus
≥11.1 (≥200) ≥7.0 (≥126) ≥48 ≥6.5
53. MANAGEMENT
Lifestyle
Good nutrition
Regular exercise
Diet control to maintain blood pressure.
Medications
Surgery
Pancreas transplant
kidney transplantation
Weight loss surgery
54. REFERENCES:
Harsh Mohan - Textbook of Pathology
A Book Of Clinical Biochemistry-
Jay pee Brothers Medical Publishers
Essentials of Medical Physiology
K.D. Tripathi - Essentials of Medical Pharmacology
Internet